RESUMEN
OBJECTIVES: Involving dental offices in routine vaccinations could have a positive impact on public health. In this study, we assessed dental providers' attitudes and perceptions regarding implementing vaccination in dental settings. METHODS: We performed semi-structured interviews with 31 dental providers (25 dentists and 6 dental hygienists) enrolled in the Western region of the National Dental Practice-Based Research Network as of June 28, 2021. Interviews were recorded and transcribed. We analyzed transcripts using deductive and inductive coding approaches. RESULTS: We identified three main themes that captured the perceptions of dental practitioners regarding the feasibility of implementing vaccine administration in a dental setting: (1) dental practitioners perceive contributing to the public health mission of disease prevention as having high value, (2) dental practitioners face considerable complexity when deciding whether to implement vaccine administration, and (3) dental practitioners do not understand current laws and associated reimbursement models related to vaccine administration. CONCLUSIONS: To make vaccination commonplace in dental practices, legal changes to allow dental practitioners to administer vaccines should be followed by concrete guidance and relevant trainings to help interested dental practitioners successfully implement vaccination programs in their clinical settings.
Asunto(s)
Odontólogos , Conocimientos, Actitudes y Práctica en Salud , Actitud del Personal de Salud , Estudios de Factibilidad , Humanos , Rol Profesional , Investigación Cualitativa , VacunaciónRESUMEN
Purpose This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech. Method The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context. Results Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering. Conclusion Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.
Asunto(s)
Percepción del Habla , Tartamudeo , Atención , Humanos , Habla , Encuestas y CuestionariosRESUMEN
STATEMENT OF PROBLEM: Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth. PURPOSE: The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network. MATERIAL AND METHODS: Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained. RESULTS: A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2.0). CONCLUSIONS: Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).
Asunto(s)
Síndrome de Diente Fisurado , Caries Dental , Restauración Dental Permanente , Odontólogos , Femenino , HumanosRESUMEN
PURPOSE: The experience of passing as fluent, also called covert stuttering, has been uncritically framed as an inherently negative pursuit. Historically passing has been understood as a repression of one's true, authentic self in response to either psychological distress or social discrimination. The authors of this paper seek a more nuanced understanding of passing. We ask, how must a person relate to herself in order to pass as fluent? METHODOLOGY: This is a qualitative research study in which the authors utilized the ethical theories of philosopher Michel Foucault to contextualize data obtained from semi-structured interviews with nine participants who pass as fluent. RESULTS: Rather than a repression of an authentic self our data suggests passing is more usefully understood as a form of resistance by people who stutter to a hostile society. Participants learned from experiences of delegitimization that their stuttering had ethical ramifications. Consequently, they used a variety of self-forming practices to pass and thereby achieve the privileges that come with perceived able-bodiedness. CONCLUSION: Passing as fluent is not an inauthentic form of stuttering but a form of stuttering that is produced through the use of specific technologies of communication. These technologies of communication are constituted by the unique ethical relationship of the person who stutters with herself. Passing can be understood as an active form of resistance rather than a passive form of repression. By theorizing passing as fluent as an ethical relationship, we open up the possibility of changing the relationship and performing it differently.
Asunto(s)
Comunicación , Percepción del Habla , Tartamudeo/psicología , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Tartamudeo/fisiopatologíaRESUMEN
In this article, the authors (with the assistance of colleagues from whom they solicited comments), provide a forward-looking perspective on research and clinical work in fluency disorders in the next 10-15 years. Issues discussed include neurology, genetics, early intervention, and clinical training in stuttering.
Asunto(s)
Trastornos del Lenguaje , Investigación/tendencias , Tartamudeo , HumanosRESUMEN
BACKGROUND: This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. METHODS: Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. RESULTS: The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). CONCLUSIONS: One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. PRACTICAL IMPLICATIONS: Pain in the muscles and temporomandibular joints was reported as frequently as that in the teeth and surrounding tissues in patients visiting general dentists. Although the dental curriculum is concentrated on the diagnosis and management of pain and related conditions from teeth and surrounding tissues, it is imperative to include the training for other types of orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues.
Asunto(s)
Dolor Facial/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Músculos Faciales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noroeste de Estados Unidos/epidemiología , Distribución de Poisson , Prevalencia , Factores Sexuales , Articulación Temporomandibular , Odontalgia/epidemiología , Adulto JovenRESUMEN
PURPOSE: In order to determine whether adults who stutter (AWS) would show changes in locus of causality during stuttering treatment and approximate those of adults who do not stutter (AWNS) this preliminary study compared the locus of causality as indicated by Origin and Pawn scaling procedures from two groups of young adults who do and do not stutter. METHOD: A total of 20 age- and gender-matched undergraduate and graduate students who did (n = 10) and did not (n = 10) stutter participated. The AWS took part in a three week intensive stuttering treatment provided by the American Institute for Stuttering (AIS). Along with measures of treatment outcome, writing samples were analyzed for Origin and Pawn statements that indicated the participant's locus of causality. RESULTS: At the outset of treatment the AWS showed significantly greater Pawn scores than the control group of AWNS and similar occurrences of Origin statements. The AWS showed a statistically significant increase in pre- to post-treatment Origin scores and a statistically significant decrease in Pawn scores. Following treatment the AWS showed the Origin and Pawn score ratios similar to those of AWNS. CONCLUSION: A pattern of increasing Origin and decreasing Pawn scores may indicate a pattern of increasing agency during successful stuttering treatment. Moreover the post-treatment Origin and Pawn score ratios of AWS, which were not significantly different from those of AWNS, may indicate a change trend toward normalization. Further research will determine whether such change patterns are predictive of long-term maintenance. EDUCATIONAL OBJECTIVES: By reading this article the reader will be able to: (a) describe advantages of content analysis measure such as the Origin and Pawn Scales; (b) discuss the purposes and procedures of the Origin and Pawn Scales; (c) describe typical change pattern of Origin and Pawn scores of adults who stutter while receiving treatment; (d) discuss how successful treatment for stuttering can result in the normalization of one's locus of causality.
Asunto(s)
Control Interno-Externo , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Lectura , Índice de Severidad de la Enfermedad , Logopedia/psicología , Tartamudeo/psicología , Tartamudeo/terapia , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To examine the associations of trait anxiety (STAI), social anxiety (SIAS), depression (BDI-II), and personality features (ADP-IV) with three measures of stuttering severity: %SS, Stuttering Severity, Instrument, and the Overall Assessment of the Speaker's Experience of Stuttering. METHOD: Fifty adults with a history of stuttering served as participants. Participant scores on trait, anxiety, social anxiety, depression, and personality features were entered into a regression analysis, with the criterion variables (DVs) being: %SS, SSI-3, OASES total score. In order to explore the OASES, further, each of the four OASES subscales were also examined. A separate regression was conducted for, each dependent variable. RESULTS: The OASES total score model was significant (p<.0001) and revealed that social anxiety and, trait anxiety were the only significant predictors, with medium effect sizes noted for both variables. In contrast, percent syllables stuttered and the SSI were not significantly associated with psychological, variables, suggesting that anxiety may not always be related to overt indicators of stuttering. Depression and personality dysfunction were not significantly associated with any measure of, stuttering severity. CONCLUSION: Anxiety in the form of social and trait anxiety are significantly associated with stuttering, severity as indicated by the OASES. Traditional procedures for assigning severity ratings to individuals, who stutter based on percent syllables stuttered and the Stuttering Severity Instrument are not, significantly related to psychological processes central to the stuttering experience. Depression and, personality characteristics do not meaningfully account for stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (a) differentiate forms of anxiety that are likely to be associated with stuttering (b) understand the importance of determining features of stuttering that go beyond the obvious, surface characteristics of stuttering frequency, and (c) discuss the important clinical and theoretical implications for understanding the degree of psychological dysfunction that is likely to be characteristic of those who stutter.
Asunto(s)
Ansiedad/psicología , Comunicación , Depresión/psicología , Trastornos de la Personalidad/psicología , Tartamudeo/psicología , Adolescente , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Persona de Mediana Edad , Personalidad , Trastornos de la Personalidad/diagnóstico , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Índice de Severidad de la Enfermedad , Tartamudeo/diagnóstico , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: Given reports of the frequent occurrence of personality disorders (PD) among individuals who stutter, this investigation was designed to determine the presence of personality disorders (PD) for individuals seeking treatment for stuttering, using a different self-report measure. METHOD: The sample included 50 adults who were undergoing treatment for stuttering. The participants also completed a self-report measure (Assessment of the DSM-IV Personality Disorders, ADP-IV) that is known to have good differential validity in the assessment of personality disorders as well as good convergent validity with a structured interview administered by a skilled mental health professional. RESULTS: Four participants met threshold values for one personality disorder (PD) and one participant met criteria for two personality disorders. The remaining 45 participants (90%) did not meet criteria for a PD. CONCLUSION: Rates of observed PDs in this sample approximated rates that have been observed in general community samples using structured clinical interviews and trained interviewers. Related reports which have claimed high levels of personality disorders among adults who stutter appear to be inflated by the use of self-report devices that overestimate the occurrence and co-morbidity of these conditions. Implications for the treatment of adults who stutter are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to (a) summarize two basic perspectives of how individuals who stutter are influenced by the possibility of personality dysfunction (b) describe the factors that influence the detection of personality dysfunction using self-report procedures, discuss the important (c) theoretical and (d) clinical implications of accurately identifying personality dysfunction for adults who stutter.
Asunto(s)
Trastornos de la Personalidad/epidemiología , Tartamudeo/psicología , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personalidad , Trastornos de la Personalidad/etiología , Inventario de Personalidad , Autoinforme , Tartamudeo/complicaciones , Tartamudeo/epidemiología , Tartamudeo/terapia , Adulto JovenRESUMEN
UNLABELLED: The concepts of locus of control and locus of causality are similar and refer to the degree to which a person perceives daily occurrences to be a consequence of his or her own behavior. Locus of control is considered to be a unidimensional construct indicating an inverse relationship between the polls of internality and externality. The locus of control is generally determined by using questionnaires with a limited number of items. Locus of causality is considered to be a two-dimensional construct where Origin and Pawn values, which are similar to internality and externality, respectively, are not necessarily inversely related. Locus of causality is determined by content analysis of freely spoken or written narratives. In the current study Origin and Pawn scores were obtained from twenty adults prior to and following a three-week intensive stuttering treatment program. Brief narratives written by the participants were analyzed to obtain Origin and Pawn values. These scores were compared with traditional measures of therapeutic outcome (Locus of Control, OASES, PSI, percentage of syllables stuttered). Results indicated statistically significant increases in pre- to post-treatment Origin scores (p=.001; Cohen's d=1.44) and statistically significant decreases in pre- to post-treatment Pawn scores (p=.003; Cohen's d=1.11). Origin and Pawn scores showed significant relationships with other measures of stuttering, indicating concurrent and construct validity. Origin and Pawn scaling procedures appear to provide a valid, sensitive, and nonreactive indicator of the speaker's locus of causality and ability to develop an autonomous and agentic lifestyle. EDUCATIONAL OBJECTIVES: After reading this article, the readers will be able to: (1) distinguish between the concepts of locus of control and locus of causality, (2) describe the characteristics of individuals behaving as an Origin and a Pawn, (3) differentiate patterns of change for Origin and Pawn scores prior to and following treatment, and (4) describe the clinical advantages using Origin and Pawn scaling procedures for individuals who stutter.
Asunto(s)
Control Interno-Externo , Tartamudeo/psicología , Adulto , Femenino , Humanos , Masculino , Pruebas Psicológicas , Índice de Severidad de la Enfermedad , Logopedia/psicología , Tartamudeo/terapia , Resultado del TratamientoRESUMEN
UNLABELLED: The treatment components that contribute to and account for successful therapeutic outcomes for people who stutter are not well understood and are debated by many. The purpose of this phenomenological study was to describe in detail the underlying factors that contribute to a successful or unsuccessful therapeutic interaction between clients and their clinicians. Twenty-eight participants, 19 men and 9 women, who had received from 6 months to more than 12 years of therapy for stuttering were studied. The participants were asked to consider their experience with one or more speech-language pathologists with whom they had received fluency therapy and to describe the characteristics that made that individual effective or ineffective in promoting successful change in their ability to communicate. Analysis of these data resulted in 15 primary categories. Finally, the essential structure of an effective and ineffective therapeutic interaction was described. Results highlighted the importance for effective therapy of understanding the stuttering experience, forming a positive client-clinician, alliance, and being knowledgeable about stuttering and its treatment. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with an effective therapeutic interaction, (2) describe, from the perspective of a select group of adults who stutter, the themes associated with an ineffective therapeutic interaction, and (3) describe the ways in which an effective or ineffective therapeutic interaction could impact a person who stutters.
Asunto(s)
Satisfacción del Paciente , Relaciones Profesional-Paciente , Tartamudeo/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Patología del Habla y Lenguaje/normas , Tartamudeo/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
This article addresses the issue of clinically significant (or meaningful) change resulting from treatment for stuttering. Research in both medical and behavioral fields indicates that clients often have their own unique perspective of meaningful clinical change and that this perspective is often different from that of the professional administering the treatment. Among the variables that the client brings to the treatment session are their progression through stages of therapeutic change and the ways in which they believe they are capable of coping with their problem. Research has shown that how an individual interprets the meaning his or her therapeutic experience is central to clinically significant change. Procedures for obtaining feedback from clients concerning clinically significant change and the quality of the therapeutic alliance are described.
Asunto(s)
Evaluación de Resultado en la Atención de Salud/métodos , Relaciones Profesional-Paciente , Logopedia , Tartamudeo/terapia , Adaptación Psicológica , American Speech-Language-Hearing Association , Consejo , Curriculum/tendencias , Retroalimentación Psicológica , Predicción , Humanos , Satisfacción del Paciente , Psicoterapia , Garantía de la Calidad de Atención de Salud/tendencias , Logopedia/educación , Tartamudeo/psicología , Estados UnidosRESUMEN
BACKGROUND: Methods used by dental practitioners to diagnose and treat dentin hypersensitivity are not well documented. The authors conducted a survey of dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) to ascertain the treatment methods they used. Methods. Via an Internet survey, the authors collected data regarding methods used for diagnosis and treatment of dentin hypersensitivity from 209 Northwest PRECEDENT dentists. RESULTS: The PRECEDENT dentists indicated that they most often used fluoride varnishes and gels, advice regarding toothbrushing and diet, bonding agents, restorative materials and glutaraldehyde/2-hydroxyethyl methacrylate (HEMA) to treat dentin hypersensitivity. They reported that the most successful treatments were fluorides, glutaraldehyde/HEMA, bonding agents, potassium nitrates and restorative treatments; they considered observation, advice regarding toothbrushing and diet and laser therapy to be the least successful. Dentists listed fluorides, calcium phosphates, glutaraldehyde/HEMA and bonding agents as the treatments most desirable for inclusion in a future randomized clinical trial of dental hypersensitivity treatments. CONCLUSIONS: Dentists rely on patients to assess the severity of dentin hypersensitivity. Modalities for the diagnosis and treatment of hypersensitivity are diverse. Methods used to diagnose and treat dentin hypersensitivity in practice are challenging to justify. CLINICAL IMPLICATIONS: Practitioners should be aware of the diversity of methods available for diagnosing and treating dentin hypersensitivity as they manage the care of their patients with this condition.
Asunto(s)
Investigación Dental/organización & administración , Desensibilizantes Dentinarios/uso terapéutico , Sensibilidad de la Dentina/diagnóstico , Adulto , Fosfatos de Calcio/uso terapéutico , Recolección de Datos , Cementos Dentales/uso terapéutico , Restauración Dental Permanente , Sensibilidad de la Dentina/terapia , Femenino , Fluoruros Tópicos/uso terapéutico , Glutaral/uso terapéutico , Humanos , Sistemas de Información , Masculino , Persona de Mediana Edad , Noroeste de Estados Unidos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
UNLABELLED: Given the well-documented understanding that stuttering behavior elicits stereotypically negative responses from listeners, two experiments explored the equivocal results of earlier investigations concerning the potential for self-acknowledgment and modification of stuttering to elicit positive responses from naïve (unfamiliar with stuttering) listeners. In the first experiment, listeners viewed one of four video conditions of an adult male speaker presenting combinations of stuttering, self-acknowledgment, and stuttering modification. Using a semantic differential scale, participants responded with non-significant (p>.05) differences across conditions. In the second experiment, participants listened to two randomly assigned conditions containing speech with stuttering and speech with stuttering and acknowledgment, providing them with the opportunity to experience both situations. In this case, statistically significant (p=.004) differences were found with moderately (Cohen's d=.59) more favorable responses by listeners when self-acknowledgment of stuttering occurred. The results of the current study help to explain the conflicting findings of previous investigations and indicate that when naïve listeners have an opportunity to contrast conditions of stuttering with and without acknowledgment, perceptions about the characteristics of the speaker are more likely to be favorable when the speaker self-acknowledges stuttering. It is suggested that the capability of a speaker to self-acknowledge his or her stuttering reflects the person's adoption of more effective coping strategies and that a positive listener response is likely to be associated with the speaker's ability to inform the listener about the nature of stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the formation of negative responses toward stuttering, (2) describe how to change negative responses toward stuttering, and (3) describe benefits of stuttering acknowledgment and modification.
Asunto(s)
Actitud , Autorrevelación , Percepción del Habla , Tartamudeo/psicología , Tartamudeo/rehabilitación , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prejuicio , Medición de la Producción del Habla , Estereotipo , Grabación en Video , Adulto JovenRESUMEN
UNLABELLED: As with the first of two companion manuscripts, this investigation employed a grounded theory approach to identify patterns of coping responses by adults responding to the stress resulting from the threat of stuttering. The companion paper described emotion-based avoidant coping responses that were used to protect both the speaker and the listener from experiencing discomfort associated with stuttering. This paper describes two cognitive-based approach patterns that emphasize self-focused and problem-focused forms of coping. The first of the cognitive-based coping patterns involved speakers approaching stuttering with a broader perspective about themselves and the experience of stuttering, resulting in an improved self-concept and increased self-confidence. The second coping pattern involved speakers focusing on their own goals which results in increased agency and self-confidence. Participants described the development of more functional coping responses. They moved from emotion-based avoidant patterns of coping that focused on protecting the self and the listener from experiencing discomfort associated with stuttering to cognitive-based approach patterns that focused on the needs of the speaker. As the participants chose to approach rather than avoid or escape stuttering, they experienced many positive social, physical, cognitive, and affective results. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence coping choices, and (4) explain the factors that contribute the use of approach-oriented and agentic coping strategies.
Asunto(s)
Adaptación Psicológica , Cognición , Relaciones Interpersonales , Autoimagen , Tartamudeo/psicología , Adulto , Actitud Frente a la Salud , Conducta de Elección , Educación Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Solución de Problemas , Tartamudeo/terapia , Adulto JovenRESUMEN
UNLABELLED: Using a grounded theory approach, four clusters were identified that represent patterns of coping by adults who stutter. In order to understand the complexities within the coping responses of speakers to the experience of stuttering, this first of two companion papers summarizes the literature on the human coping response to stress and the nature of two of the four main findings identified. These findings describe a coping process that emphasizes strategies of protecting both the speaker and the listener from experiencing discomfort associated with stuttering. The companion paper describes the remaining two main findings that emphasize the characteristics of self-focused and action oriented coping responses. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with the process of coping with stuttering, (2) describe the basic rationale for the procedures associated with grounded theory methods, (3) describe the factors that influence the choice to use emotion-focused and problem-focused coping strategies, and (4) explain the factors that contribute to the use of methods of escape.
Asunto(s)
Adaptación Psicológica , Emociones , Relaciones Interpersonales , Tartamudeo/psicología , Adulto , Educación Continua , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Estrés Psicológico , Adulto JovenRESUMEN
UNLABELLED: The purpose of this investigation was to understand, from the perspective of the speaker, how seven adults have been able to successfully manage their stuttering. Individual experiences were obtained across the three temporal stages (past, transitional, and current). Recurring themes were identified across participants in order to develop an essential structure of the phenomena at each stage. The ability to make the transition from unsuccessful to successful management of stuttering was associated with six recurring themes of: (1) support, (2) successful therapy, (3) self therapy and behavioral change, (4) cognitive change, (5) utilization of personal experience, and (6) high levels of motivation/determination. Six recurring themes associated with past experiences, when stuttering was unsuccessfully managed, included: (1) gradual awareness, (2) negative reactions of listeners, (3) negative emotions, (4) restrictive lifestyle, (5) avoidance, and (6) inadequate therapy. The five recurring themes identified for the current situation where stuttering continues to be successfully managed were: (1) continued management, (2) self acceptance and fear reduction, (3) unrestricted interactions, (4) sense of freedom, (5) and optimism. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe, from the prospective of a select group of adults who stutter, the recurring themes associated with both unsuccessful and successful management of stuttering, (2) explain the recurring themes associated with how this group of seven adults achieved successful management of their stuttering, and (3) discuss the basic rationale and procedures associated with phenomenological analysis.
Asunto(s)
Actitud Frente a la Salud , Logopedia/métodos , Tartamudeo/terapia , Adulto , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apoyo Social , Resultado del TratamientoRESUMEN
During a long-term study, a rat exposed to half-amplitude band pass fluorescent blue light (434 to 475 nm) and receiving a calcium channel blocker developed an ocular mass. By visual examination, a presumptive diagnosis of ocular melanoma was made. Subsequent surgical removal of the eye, followed by histopathology, confirmed the lesion as a highly pigmented epitheliod melanoma.
Asunto(s)
Enfermedades de la Córnea/veterinaria , Neoplasias del Ojo/veterinaria , Melanoma/patología , Melanoma/veterinaria , Enfermedades de los Roedores/etiología , Animales , Bloqueadores de los Canales de Calcio/efectos adversos , Enfermedades de la Córnea/etiología , Enfermedades de la Córnea/patología , Neoplasias del Ojo/etiología , Neoplasias del Ojo/patología , Técnicas Histológicas , Luz , Melanoma/etiología , Ratas , Ratas Long-Evans , Enfermedades de los Roedores/patologíaRESUMEN
UNLABELLED: Fransella [Personal change and reconstruction. London: Academic Press] suggested that persons who stutter experience a lack of meaningfulness of their fluent speaker role and demonstrated that a Personal Construct Psychology approach to therapy with persons who stutter may be useful. Few studies, however, have investigated her claims. This study investigated the "meaningfulness" with which fluent and disfluent persons were able to construe themselves in stuttering and non-stuttering speaker roles. Results indicated that persons who stuttered displayed greater cognitive anxiety (difficulty integrating their experience meaningfully) in a fluent speaking role than in a stuttering role, whereas the reverse was found for fluent speakers. These results suggest the relevance of assessing and addressing the meaningfulness of the "dominant" disfluent speaker role in treating persons who stutter, insofar as a tendency to maintain the predictability of this familiar role may contribute to stuttering maintenance and relapse. The refined guidelines developed for applying the Cognitive Anxiety Scale to the content analysis of self-descriptions of persons who stutter can make a practical contribution to this effort. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) describe the potential influence of speaker roles in the maintenance of stuttering; (2) define cognitive anxiety and how it relates to meaningful interpretations of experience; (3) detect potential signs that a person who stutters may be engaged in "defending" a stutterer role; and (4) describe the clinical implications of this view of stuttering maintenance.
Asunto(s)
Ansiedad , Cognición , Tartamudeo/psicología , Adulto , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , AutoimagenRESUMEN
UNLABELLED: Relapse following treatment for stuttering is a common problem for many clients. It has often been suggested that one factor contributing to relapse is the client's difficulty in adjusting to a new role as a fluent speaker. In this tutorial article, we first present a personal construct view of relapse, which suggests that this difficulty may be addressed by increasing the meaningfulness of the fluent speaker role for the speaker. Section 3 proposes that post-treatment success for persons who stutter may be facilitated by the use of a narrative approach to counseling in which the meaningfulness of the fluent speaker role is elaborated. In this approach, clients are guided through a process of deconstructing their stuttering-dominated personal narrative, followed by the reconstruction of an alternative narrative that is more compatible with being a fluent speaker. EDUCATIONAL OBJECTIVES: The reader will (1) learn about a personal construct psychology perspective on resistance and relapse in stuttering therapy, (2) be able to describe a narrative approach to counseling for people who stutter that is directed toward the long-term maintenance of fluent speech and the steps of deconstruction of the dominant stuttering narrative and reconstruction of a new, more fluent personal narrative, and (3) be able to prepare a series of narrative interview questions with which to engage clients in conversations that may facilitate the deconstruction and reconstruction processes.